Understanding the experience of financial toxicity in patients with metastatic cancers referred to specialist palliative care in India –A qualitative study

Cancer is the leading cause of morbidity and incresaed mmortality worldwide. The incidence is increasing with aging population.

While, huge research and developmnet initiatives are underway to improve the existing cancer care infrastructure, the disease continues to takle heavy toll on ptaient’s lives.

With the advent of technological advances, newer diagnostic and therapeutic options have become available in last two decades. Although, thses new drugs are more effective, the affordibility is a huge challenge.

In medicine , the term financial toxicity (FT) is used to describe problems  a patient experiences in relation to cost of medical care. FT is an unintended outcome- an adverse event of cancer care given the cost of treatment. It has two key components- 1) Objective financial burden, in the form of cost of vtreatment patient has to pay, and 2) Subjective financial distress- which is reflected in form of worry, anxiety, loss od assets and savings.

FT affects patient’s quality of life and access to medical care. To cope with financial burden, patients take less than prescribed medicine, or may at times completely avoid to purchase them. They compromise leisure activity, may spoend less on food and clothings, have to work for longer hours, just to meet increased financial expenses.  Patients with metastatic disease, experience reduction in quality of life domains including- physical, social, spiritual, and emotional well being. Same is true for adult survivors of childhood cancers.

Lesser knowledge and awareness of available healthcare benefit options, insurance schemes sontributes to some extents towards financial stress during treatment.

We note that the concept of financial toxicity, though well reported in literature, has not been so well reported in Indain cancer patients. In developing country like India, the effects of economic aspects of cancer care are far more reaching with long term effects on patients and their families.  So we wish to explore and report the experience related to financial toxicityin Indian cancer patients.  This study aims to understand the financial toxicity as experiencxed by the patients with metastatic cancers referred to specialist palliative care. It will help to add information on fianancial domain of cancer care in Indian population and will help in making future strategies to tackle financial stress of cancer care.